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Doctors can help prevent teen smoking, panel says

Children and teens may hear about the dangers of smoking from parents, teachers and friends, but they may be less likely to take up deadly habit if they hear the message from doctors, too, a task force says.

Children and teens may hear about the dangers of smoking from parents, teachers and friends, but they may be less likely to take up the deadly habit if they hear the message from at least one more important person: their doctor.

That's the conclusion of an influential panel publishing new recommendations today in two medical journals, the Annals of Internal Medicine and Pediatrics. In a number of studies, kids were less likely to try smoking if they got some kind of counseling or education from their doctors or other health care providers, says the U.S. Preventive Services Task Force.

"We didn't recommend any particular intervention, because a variety of things seem to help," says panel member David Grossman, a pediatrician and researcher at the Group Health Research Institute and the University of Washington-Seattle. "The important thing is that the message is coming from a physician and that's an important voice … even to kids."

The report says "even very minimal interventions," such as a doctor's office mailing a series of prevention guides to parents and kids, could make a difference.

Stopping kids from ever smoking could have a huge health impact, the panel says: Smoking kills about 443,000 people a year in the United States, and 90% of smokers start before age 18.

The American Academy of Pediatrics already urges doctors to talk to parents, children and teens about smoking.

But the task force, the academy and other experts also say that broader strategies — enlisting families, communities, mass media and lawmakers — are needed to chip away at smoking initiation rates. As of 2011, about 18% of high school students and 4% of middle school students were smokers, according to the federal Centers for Disease Control and Prevention (CDC).

While those numbers have been falling, the fact that nearly one in five teens still leave high school as smokers is unacceptable, says Michael Steinberg, an internist who directs a tobacco dependence program at Robert Wood Johnson University Hospital, New Brunswick, N.J.

"We need to do everything we can to reduce a young person's opportunity to try their first cigarette or to go from experimenting to becoming addicted," he says.

In an opinion piece published alongside the task force's report in the Annals, Steinberg endorses one increasingly proposed strategy: raising the legal age to buy cigarettes to 21. A proposal to do that is under discussion in New York City, and several states and counties have already raised the age from 18 to 19, over the protests of smokers' rights advocates and some retailers. The small town of Needham, Mass., was the first to raise the age to 21, with a phased-in plan that started in 2005, and some other Massachusetts towns are following suit, says Jonathan Winickoff, a Harvard Medical School pediatrician who spearheads anti-smoking efforts for the pediatrics academy.

Raising the age to 21 could cut teen smoking rates dramatically, largely because younger teens often get cigarettes from older teens and young adults, Winickoff says. "And if you make it to 21 without smoking, your chances of ever becoming a smoker drop to about 2%," he says.

Some of the steepest drops in teen smoking have occurred since the federal government started requiring states to beef up enforcement of existing under-18 sales bans, says the federal Substance Abuse and Mental Health Services Administration. The share of retailers caught selling to minors dropped from 40% in 1997 to 8.5% in 2011, the agency says. Numbers for 2012 will be released Tuesday.

• Teens who want help can go to teen.smokefree.gov, a government website with information on text and app-based tools, or Tobacco-Free Teens, a free app in Apple iTunes stores developed by researchers at MD Anderson Cancer Center in Houston.